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Health Care Reform Legislation Enacted

 

Pennsylvania Supreme Court Upholds Gas Company Position on Leases

 

New Limitations on the Medicaid Deductibility of Other Medical Expenses

 

Personal Care Homes May Simulate Fire Drill Evacuations for Dying Residents

 

DPW Plans Expansion of LIFE Programs

 

Register for Marshall, Parker & Associates’ 14th Annual Elder Law Update on May 20 & May 21

 

Follow Marshall, Parker & Associates’ Attorneys on Twitter

 

New! Free Royalty Owners’ Workshop Set for April 14th!

 

Protecting Your Assets Workshop Set for Hazleton & Danville

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Health Care Reform Legislation Enacted

 

Written By: Attorney Jeffrey A. Marshall, CELA*

 

The biggest news of the past several weeks has been the enactment of health care reform legislation. The legislation was passed in two stages: the “Patient Protection and Affordable Care Act” and the “Health Care and Education Reconciliation Act of 2010.”

 

Although many seniors have been frightened by the disingenuous political debate surrounding reform, the law includes many provisions of benefit to older Americans. Some of these provisions will take effect within the coming year, while others will be phased in over longer periods. Among the early changes of significance to older adults are:

1. Provisions to close the Medicare prescription drug donut hole. A $250 rebate will be paid to Medicare beneficiaries who hit the donut hole in 2010. In 2011 there will be a 50% discount on brand-name drugs in the donut hole. The donut hole is to be completely eliminated by 2020.
2. Expanded coverage of preventive care under Medicare. Co-payments for preventive services are eliminated and preventive services are exempted from deductibles under the Medicare program effective January 1, 2011.
3. Help for Early Retirees. The law creates a temporary re-insurance program (until consumer friendly health insurance exchanges are available) to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64 (effective 90 days after enactment).
4. Health plans may not drop people from coverage when they get sick (effective 6 months after enactment).
5. Health plans are prohibited from placing lifetime limits on coverage and restricted in the use of annual limits that would impede access to needed care (effective 6 months after enactment). In 2014, the use of any annual limits will be prohibited.
6. States are barred from imposing new eligibility barriers for Medicaid. So-called “maintenance-of-effort” (MOE) provisions in the new law prohibit states from making it more difficult for people to become eligible for Medicaid. These MOE requirements will apply until the major components of health reform go into effect on January 1, 2014. They will help assure that budget-strapped states do not try to save money by imposing new eligibility limitations on Medicaid as health reform is being implemented.

 

The signature feature of the new law is its complicated provisions intended to achieve near universal health insurance coverage beginning in 2014. In addition, it extends the solvency of the Medicare Trust Fund by at least nine years. For a summary of other key provisions of the law, click here or see the resource links below.

 

Now that we are bringing tens of millions of uninsured into our health care system, and reforming some of the worst of the abuses of our free market insurance system, we need to turn to the hard part – controlling costs. The new health reform laws take only tentative steps in this direction.

 

The US has the most privatized free market based health care system in the world.  Not coincidently, the US has by far the most expensive health care system in the world. Unless we get our costs under better control, financial disaster awaits. The good news is that it is apparently possible to provide better overall care at a lower per capita cost.  Most other countries do so.  But the US has never been able to rationally address how we deliver and pay for health care.  Politics, self-interest, sloganeering and emotions have always been in control.  

 

Whether we seek to control costs through market forces or government mandates, the hard truth is that everyone involved with our health care system will have to accept fundamental change. To succeed, change must involve not only payment systems, but most importantly, how we deliver care. Right now care delivery is driven by our payment system. The result is high cost and low quality.

 

Cost reduction will be difficult to achieve because interests that benefit from the current system will vigorously defend their turf and oppose any change that they perceive as disadvantageous to them. But if we are to avoid bankrupting our health care system and our country, specialty physicians may have to suffer reductions in their incomes, pharmaceutical companies may have to get by with lower profits, insurance companies with high overheads may have to be driven from the marketplace, trial lawyers may have to be forced to live with medical malpractice reform, and consumers may have to get use to fewer expensive tests, more emphasis on prevention, less reliance on physicians and hospitals, and more care in the home.  

 

Of course none of these interest groups are going to want to compromise.  Look at how the new health reform law, which represents only a mild shift, has been met with hysterical over-reaction. Balancing between competing interests in a rational manner will be difficult for Congress if it continues to be driven by political and corporate self-interest, empty talking-points, and petulance.     

 

I don’t know where we will go from here. But it seems to me that the recently enacted recent health care reform legislation needs to be just the beginning of the beginning. 

 

Here are some links to additional resources and information on the new health reform laws:

 

Full Text of the Patient Protection and Affordable Care Act (P.L. 111-148)

 

Full Text of the Health Care and Education Reconciliation Act of 2010  

 

Democratic Policy Committee Summary & Analysis of the two enactments

 

The Patient Protection and Affordable Care Act, Section by Section Analysis

 

Summary of The Health Care and Education Reconciliation Act

 

Health Insurance Reform: A Guide for Seniors

 

 

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552.

More information about Attorney Marshall is available on our website at www.paelderlaw.com/staff.html

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Pennsylvania Supreme Court Upholds Gas Company Position on Leases

 

Written By: Attorney Dale A. Tice

 

Pennsylvania’s highest court has upheld the ruling of a Susquehanna County judge validating natural gas leases that allow gas companies to deduct post-production costs from the landowners’ royalties.

 

Landowners had filed over 70 lawsuits in state and federal courts seeking to invalidate the leases because state law guarantees landowners a minimum one-eighth royalty on oil and gas production.  The landowners argued that subtracting costs to treat and transport the gas reduced their royalties below the state guaranteed minimum.

 

The stakes were high for the gas companies as a landowner-friendly ruling could have invalidated thousands of leases. The gas companies suggested that landowners who had signed early at low prices were attempting to invalidate the leases in the hope of renegotiating more favorable terms in light of the increased interest in the Marcellus Shale.

 

In a unanimous decision authored by Justice Max Baer, the court noted that the Minimum Royalty Act did not define the term “royalty” or provide a method for calculating the landowners’ royalty.  Citing numerous academic treatises, the court concluded that Pennsylvania’s Minimum Royalty Act should be read to allow the deduction of post-production costs in the calculation of royalties at the wellhead.

 

The Pennsylvania Supreme Court had exercised extraordinary jurisdiction over the many cases that had been filed to provide a final resolution of the matter for all of the parties involved and to avoid the possibility of conflicting decisions from the various courts addressing the issue.

 

 

The law firm of Marshall, Parker & Associates recognizes the need for quality legal counsel in this area of law that is new to northcentral and northeastern Pennsylvania.  We are pleased to offer the services of Attorney Dale A. Tice. Dale has extensive experience reviewing oil and gas leases and negotiating lease terms for landowners.  He has presented numerous educational programs with the Penn State Cooperative Extension, and has served as a faculty member presenting educational seminars for lawyers with the Pennsylvania Bar Institute.  Please contact Dale for assistance with review and negotiation of an oil and gas lease or if you have questions related to oil and gas leasing. You can also visit our website at www.pagaslaw.net for more information or to register for one of our free Royalty Owner’s Workshops.

 

 

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Attorney Marshall is available on our website at www.paelderlaw.com/staff.html

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New Limitations on the Medicaid Deductibility of Other Medical Expenses

 

Written By: Attorney Jeffrey A. Marshall, CELA*

 

To qualify for Medical Assistance to help pay for long term care costs, seniors must qualify financially. One of the financial requirements is that the senior’s income must be low enough to meet the Medicaid program’s guidelines. Another is that senior who is receiving Medicaid financed nursing home care must contribute from their income towards the cost of care.

 

In determining income qualification for elderly residents of long-term nursing facilities, Pennsylvania is one in a number of states that permits an individual to “spend down.” This means that residents whose income would otherwise be too high for them to qualify for Medicaid are permitted to deduct their medical expenses from income to “spend down” to the income qualification threshold. This is referred to as a “medically needy” methodology for determining Medicaid income qualification.

 

Once a senior qualifies for Medical Assistance for nursing home care, the senior must use his or her income as a co-payment towards the cost of care.  However, a Medical Assistance recipient can retain certain amounts that are allowed as “deductions” for purposes of determining the co-payment obligation. One of these allowable income deductions is for medically-necessary expenses incurred by the nursing home resident which are not paid by Medicaid. These are sometimes known as “Other Medical Expenses” or “OME.” 

 

In the past, Pennsylvania had tried to a place a dollar limit on the amount of OME an individual can deduct in calculating the co-payment obligation.  But this type of dollar cost limitation was determined to violate federal Medicaid requirements.

 

Because there is no dollar limit on the deduction of OME, individuals have been able to use medical expenses incurred during transfer penalty periods and medical expenses incurred at the private pay facility rate for extended periods of time as medical expense deductions. This can effectively reduce or even eliminate an individual’s payment toward the cost of long-term care services for an extended period of time. Those costs end up being paid by Medicaid.

 

Act 54 of 2009 was enacted to address this issue and reduce the potential cost burden on Medicaid. Although Federal law does not permit the kind of dollar limitations on deductibility that Pennsylvania once imposed, it does allow Pennsylvania to place “reasonable limits” on the ability to deduct OME. Act 54 of 2009 (Senate Bill 47 enacted December 17, 2009) revised Pennsylvania law to establish limitations that are intended to be in accord with federal Medicaid requirements.

 

On March 24, 2010, DPW issued OPS100303 which is the Department’s guidance to County Assistance Office caseworkers on the new rules for the limitation on the OTE that can be deducted when calculating the required payment towards cost of care. The guidance states that medical expenses are not deductible if the expense was incurred (1) for long term care expenses incurred six months or more prior to the application for MA, or (2) for long term care expenses incurred as a result of an imposed penalty.

 

In addition to impacting some seniors, these limitations may have a negative impact on nursing facilities which sometimes must rely on the OME rules to get paid for expenses a resident incurred prior to qualifying for Medical Assistance.  View a copy of OPS100303.

 

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Attorney Marshall is available on our website at www.paelderlaw.com/staff.html

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Personal Care Homes May Simulate Fire Drill Evacuation for Dying Residents

 

Written By: Attorney Jeffrey A. Marshall, CELA*

 

Of the 48,000 Pennsylvania residents served in personal care homes, it is estimated that 3,000 residents in a given year receive hospice care and services in the home. As the provision of hospice care and services in homes has increased, questions have been raised about the procedures to be followed while the resident is actively dying.

 

The Department of Public Welfare has recently issued a statement of policy that allows personal care homes an option to simulate the fire drill evacuation process to avoid disturbing an actively dying resident. 

 

The new policy, which takes effect on April 12, 2010, is available here.

 

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Attorney Marshall is available on our website at www.paelderlaw.com/staff.html

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DPW Plans Expansion of LIFE Programs

 

Written by: Attorney Jeffrey A. Marshall, CELA*

 

The Department of Public Welfare has announced its intention to expand the Living Independence for the Elderly (LIFE) Program to the following counties:

Bedford Bradford Cameron Carbon Clearfield

Clinton Elk Fulton Huntingdon Jefferson

Juniata Mifflin Montgomery Perry Potter

Somerset Sullivan Susquehanna Tioga Wayne

LIFE is a home based alternative to nursing facility care.  It provides a full range of preventive, primary, acute and long term care services to allow individuals over age 60 who are nursing facility clinically eligible to remain in the community. 

 

Organizations interested in being considered to provide services under LIFE should submit a letter of interest, along with a copy of a completed feasibility study to Bureau of Community Development, Office of Long- Term Living, 555 Walnut Street, 5th Floor, Harrisburg, PA 17101. Current LIFE providers interested in expanding beyond their designated zip code area are also invited to respond. Responses should be directed to the previously listed address and include a letter of interest, along with a market analysis of the area of interest.  More information on the LIFE program is available here.   

 

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Attorney Weber is available on our website at www.paelderlaw.com/staff.html

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Marshall, Parker & Associates’ 14th Annual Elder Law Update

Written By: Melissa Bottorf, Director of Education & Business Development  

Part of our mission at Marshall, Parker & Associates is to empower the senior support community through networking, communication and education. With this purpose, each year we invite experts, both local and from across the state and nation, to present at our annual Professional Update. This free, half-day conference provides local elder network professionals with information about the changes affecting their consumers and an opportunity to network with hundreds of their colleagues. It has become one of the region’s most widely-anticipated professional events of the year.

 

This year’s Update will be held on Thursday, May 20, 2010 at the Williamsport Genetti Hotel and on Friday, May 21, 2010 at the Hilton Scranton & Convention Center. Registration and breakfast begins at 7:30 AM and the event concludes at 12:00 PM. If you are a professional who provides services to seniors, you can register to attend online or by calling 1-800-401-4552.

In addition to our great line-up of speakers, and exhibitor tables, continuing education credits are available or pending at little or no cost for Accountants, Attorneys, Social Workers, Personal Care Home Administrators, Nurses and Certified Financial Planners.

 

More information on the conference is available at:

www.paelderlaw.com/2010ProfUpdate.html

 

The support from this year’s sponsors is greatly appreciated. Please stop by and visit their exhibit tables at the conference.

SouthernCare	Griswold Special Care	Merrill Lynch
Elmcroft of Loyalsock	LIFE Geisinger	Elmcroft of Lewisburg
Interim Home Health Care	Comfort Keepers	Health South
Home Instead Senior Care	Hospice of the Sacred Heart	Elder Care Solutions
Misercordia University Department of Social Work	Northcentral PA Estate Planners Council	Bloomsburg University Department of Nursing

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Follow Our Staff on Twitter

 

As an additional way to help you stay on top of the ever-changing issues affecting our clients, several Marshall, Parker & Associates’ attorneys are now “tweeting” on Twitter. You can follow Jeff Marshall at http://twitter.com/ElderLawGuy, Dale Tice at http://twitter.com/PAGasLawGuy and Brenda Colbert at http://twitter.com/PASpecialNeeds

 

Just click on the link above or on the Twitter link below to check out their tweets.

 

Jeff is giving is “followers” links to online articles he is reading on issues of importance to seniors and to people who may need long term supports and services. Dale is providing his “followers” with the latest information about Pennsylvania’s Marcellus shale industry and its effect on landowners. And, Brenda is tweeting about special needs planning. Here are some examples:

                           

              Concerns raised over Medicare billing at nursing homes - http://tinyurl.com/yg7fzmo

 

              The Best and Worst State Practices in Medicaid Long-Term Care - http://tinyurl.com/yj8p7rg

 

              Eric Dishman: Take health care off the mainframe - http://tinyurl.com/yd8hm86

 

              Pa Supreme Court validates gas leases that deduct post-production costs from the landowners' royalty payments -

              http://tinyurl.com/y8ngrjt

 

              Norwegian oil and gas company Statoil is acquiring more Marcellus acreage through Chesapeake Energy-

              http://tinyurl.com/y8l3uzm

 

              Disability Rights Network of PA offers free informational brochures on preserving SSI benefits if return to work-

              http://tinyurl.com/yayf6hy

                           

For those of you who aren’t familiar with Twitter, it’s basically “micro-blogging.” Writers are forced to communicate in 140 characters or less (which is exceedingly tough for lawyers to do). You can get lots of information very quickly.  It’s free to sign up. Plus, it’s fun.  Sign up to be able to access all of their “tweets.”

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New! Free Royalty Owners’ Workshop Set for April 14th!

 

No question, the past year has surely been an exciting one for landowners in the Marcellus Shale regions of Pennsylvania. Terms like “division orders,” “decimal interests” and “royalties” are now more than just buzzwords - you need to understand them to know your rights and responsibilities and to protect yourself and your family.

 

Join Marshall, Parker & Associates for a FREE Royalty Owner’s Workshop on

Wednesday, April 14, 2010 at 6:30 PM at the Lawrenceville Fire Company.

 

Register online at http://www.pagaslaw.net/Events.html or call 1-800-401-4552

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Join Marshall, Parker & Associates for our FREE Consumer Workshops to

Learn How to Protect Your Home & Assets from Long Term Care Costs

 

- Protect Your Home & Assets from Long Term Care Costs

Saturday, April 17, 2010 from 10:00 AM until 12:00 PM at The Frost Valley Country Club in Danville

- Protect Your Home & Assets from Long Term Care Costs

Saturday, April 17, 2010 from 10:00 AM until 12:00 PM at Mea’s Restaurant in Hazleton

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Contacting Marshall, Parker & Associates for Assistance 

 

Marshall, Parker & Associates is a nationally recognized law firm which provides long-term care planning, estate planning, gas royalty owner planning, special needs planning, & estate administration services to Pennsylvania clients from our offices in Jersey Shore, Williamsport, Wilkes-Barre and Scranton. Marshall, Parker & Associates is the ONLY law firm in the United States with more than two Certified Elder Law Attorneys (CELAs) on its staff.  Five of our attorneys are CELAs.  Only a lawyer who meets all of the certification requirements set by the Pennsylvania Supreme Court is recognized as a CELA. The coveted status has only been attained by 37 attorneys in Pennsylvania.  The Pennsylvania Supreme Court approved the CELA professional designation because it found that the CELA certification process provides valuable assurance to the public that the lawyer has an in-depth working knowledge of the legal issues impacting the elderly. If you or someone you know needs assistance with estate or gas royalty planning or with qualification for Medicaid benefits for nursing home or home care, you can trust the lawyers at Marshall, Parker & Associates. Please call us toll free at 1-800-401-4552 or e-mail our Scheduling Coordinator, Lynn Wesley at webmail@paelderlaw.com.

 

Back issues of The Elder Care Law Alert are available on our website. 

 You can even search our site by a keyword or phrase!

 

Do you have a friend or colleague who would enjoy reading the Elder Care Law Alert?  If so, please feel free to forward it to them. Simply use the “Forward” button on your e-mail program.

 

To subscribe or unsubscribe to the Elder Care Law Alert,  simply send your request to:

webmail@paelderlaw.com  

*Attorneys Marshall, Parker, Grebas, Weber & Colbert are all certified as Elder Law Attorneys by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court.

**In addition to her law degree and CELA status, Attorney Colbert holds an advanced legal degree (LLM) in Estate Planning from the University of Miami School of Law.

 

 

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